Provider Demographics
NPI:1972311686
Name:ROBERSON, CARIS
Entity type:Individual
Prefix:
First Name:CARIS
Middle Name:
Last Name:ROBERSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1000 WOODCOCK RD STE 100A
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32803-3511
Mailing Address - Country:US
Mailing Address - Phone:407-550-8696
Mailing Address - Fax:321-241-1171
Practice Address - Street 1:1000 WOODCOCK RD STE 100A
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32803-3511
Practice Address - Country:US
Practice Address - Phone:407-550-8696
Practice Address - Fax:321-241-1171
Is Sole Proprietor?:No
Enumeration Date:2024-12-27
Last Update Date:2024-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician